Friday, June 26, 2009

Healthcare "Rationing"

Here is a handy-dandy way to determine whether the failure to order some exam or treatment constitutes rationing: If the patient were the president, would he get it? If he'd get it and you wouldn't, it's rationing.

Seriously, could he propose a less useful measure? Surprise! Every health insurance plan in the nation, from the worst to the best, is "rationing" because the President gets the undivided attention of Bethesda Naval Hospital when he gets, you know, an unexplained rash... or possibly even a splinter (there's a lot of old furniture, er, antiques, in the White House - it could happen). Certainly when he chokes on a pretzel or has a colon polyp. (And don't get me started on the "rationing" of fully staffed mansions, private jets, private helicopters, luxury retreats....)

Next, is Kinsley going to tell us that it's "rationing" that wealthy people can pay thousands of dollars to have a multi-day, multi-disciplinary physical examination at the Mayo Clinic, while most people get at best half an hour in the office of their family doctor? Sure, we can call it rationing, but even before considering costs there aren't enough doctors in the world to provide that level of care to every person in the U.S. And there's not a health insurance policy in the world that doesn't "ration" - by Kinsley's standard, severely ration.

It may seem absurd to worry about whether wealthy or well-insured people get every last test and exotic or speculative treatment when millions of Americans have no health insurance and millions more have gaping holes in their coverage. But the well-insured happen to include virtually all the people making the key decisions about health-care reform - members of Congress and their staffs, the White House staff, Washington journalists, and so on. These people's fears that they would lose the right to "choose my own doctor" (code for getting treatment with all the bells and whistles) helped kill Hillary Clinton's attempt to reform health care in the early 1990s. Fear of rationing could kill Obamacare for the same reason.

Let's assume its historical accuracy - that Kinsley and his friends got worked up at the notion that Hillary Clinton's healthcare reforms would have narrowed their coverage under their gold plated health insurance plans. Is Kinsley telling us that their narrow self-interest caused this nation's political and media leaders to lie to the public - to say, "You won't get to choose your own doctor," when they actually meant, "I would have to pay for more of my own healthcare"? And we're getting another round of deliberate lies from the same people, under the guise of "rationing"?

Another point Kinsley should make is that "rationing" under Obama's plan would only occur within the context of those who choose the public plan. You think you can do better under a private insurance plan? You want to buy supplemental insurance to cover things the public plan doesn't include? You'll have that right. So again, how is this "rationing" any different from the current system and how would it be worse to get additional choices?